By Kapil G. Kapoor, MD
“Am I going to do this forever, or is there going to be a different way of treating this in the future? Don’t you have a pill, or an eye drop you can give me instead?”
Frequently just before I administer treatment for macular degeneration by placing a needle in someone’s eye, patients launch existential questions, presumably stemming from their anxiety of what’s imminent. While I often start speculating with them on how their potentially blinding condition may be treated in the future, recent progress in research now allows me to offer these patients a more concrete visual of their future treatment regimen.
To this end, I recently went to San Francisco for a surgical update course. It reviewed advances in an implantable intraocular device we brought to the Mid-Atlantic region two years ago as part of a clinical trial. As an aside, microsurgical courses for ophthalmology have typically utilized pig eyes, and this course instead used a virtual reality simulator. The haptic feedback the VR simulator provided – down to the degree of hand rotation, angle of device insertion, and accuracy of placement – was phenomenal. The uniqueness of the experience resulted in a feature article in The Wall Street Journal (https://blogs.wsj.com/cio/2019/02/07/the-morning-download-genentechs-vr-effort-focuses-on-training-eye-surgeons ).
But I digress – back to saving sight. Even more remarkable than the progress in surgical training is the progress in innovative research for novel sight-saving treatments. We have known for a while that diabetic retinopathy and macular degeneration are potentially blinding diseases that have a chronic course, but they often require an enormous treatment burden with consistent intravitreal anti-VEGF injections every 1-2 months for years. Now that we’ve moved beyond demonstrating how to treat these conditions effectively, research is focusing on durability of anti-VEGF, minimizing treatment burden and our practice’s magnified research focus: reducing treatment cost.
This surgical device involves implanting a small port about the size of a grain of rice into the eye that continually releases anti-VEGF drug for sustained treatment of a blinding condition such as neovascular macular degeneration. Instead of getting consistent injections and office visits every 1-2 months, these patients are getting refills of their ports perhaps 1-2 times a year! While this remains part of a clinical trial at this point, the transformative potential in clinical efficacy and reduced treatment burden and cost is immediately apparent.
The future of anti-VEGF administration will likely utilize more durable anti-VEGF molecules as well, and we are participating in some clinical trials that utilize a medication potentially durable for 12-16 weeks instead of current molecules that last 4-8 weeks on average. Circling back to reducing costs further, we launched the very first randomized prospective trial in the world in wet AMD utilizing ziv-aflibercept, a low-cost analogue to aflibercept (Eylea). So far, it has shown non-inferiority to other anti-VEGF agents with respect to anatomy and function, and it may save patients in the United States billions of dollars each year!
As you can see, the future is here, and it’s accessible to our patients and family members right in Hampton Roads! If you or one of your patients may benefit from participation in one of our clinical trials, please reach out to our research team.
Kapil G. Kapoor, MD is a Board certified ophthalmologist specializing in vitreoretinal surgery. wagnerretina.com